Hi everyone, my name is Ashley Stewart, and today I'm going to talk to you about providing care to survivors of sexual violence using the RCMP, the Royal Canadian Mounted Police Sexual Assault Evidence Kit. Before we start, I just want to review some of the disclosures. The planners, presenters, and content reviewers of this course disclose no conflicts of interest. Upon signing in on the attendance sheet, attending the course in its entirety due to the criticality of the content, and completing the course evaluation, you will then receive a certificate that documents the continuing nursing education contact hours for this activity. The International Association of Forensic Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centre's Commission on Accreditation. My name is Ashley Stewart, and I'm a forensic nurse in Canada. And today I'm going to discuss the RCMP Sexual Assault Evidence Kit, how an individual may use it, a healthcare provider, and some of the documentation and supplies that are included in it as well. The RCMP, or Royal Canadian Mounted Police Sexual Assault Evidence Kit, is a standardized kit that is used widely by some healthcare providers across Canada. So what you will learn by the end of this session is that we will have an increased knowledge and caring for patients and survivors after sexual assault, including medical and forensic care. You'll gain an understanding of reporting options after sexual assault, and discuss principles of forensic evidence, collection techniques, and the use of the Royal Canadian Mounted Police Sexual Assault Evidence Kit. We gratefully acknowledge the Indigenous Peoples on whose ancestral homelands we gather, as well as the diverse and vibrant Native communities and people who make their homes here today. Where I'm speaking to you from, I want to acknowledge that I live and work on Treaty One territory in Winnipeg, Canada, and it is the territories and home of the Anishinaabe, Cree, Dakota, Dene, Métis, and Oji-Cree nations. The first thing I want to talk about before we get into the kit is providing care after sexual assault and sexual violence. It's really important that as healthcare providers, we recognize what our role is and what our community and what our patients and survivors need. It's really important that we don't just focus on sexual assault evidence collection, but as healthcare providers, we focus on that patient's, that survivor's holistic care and health, their medical care, their emotional and mental health well-being, and making sure they get culturally safe and appropriate care as well. We really want to make sure that patients and survivors receive trauma-informed care throughout their visit, and we'll talk about a little bit more of this as the presentation goes on. We want to make sure that our patients have options and that they are the driver of the care we are giving, and we're asking them what their priority and what their concern is when they come to see us. If it's healthcare, if they want police involved or not, those are all choices that our patients have. If you're in a center where you are triaging an individual, like an urgent care or an emergency center, we want to make sure when we're triaging that we're also providing that trauma-informed care, so that education is really important from when that survivor walks in the door to our center to the staff they encounter on their way out, to make sure that process is trauma-informed from start to finish. When triaging, we want to make sure that survivors are given privacy when they're asked what their entrance complaint is or what has happened to them. We want to make sure it's in a private environment. Is there a quieter or more of a private area that those questions can be asked? We also want to make sure that we're only asking individuals what we need to know to start the process. So at triage or that initial encounter, it may not be necessary to get into all the details of what happened to them, but just to know a general idea of what brought them in and if there's any emergent medical concerns going on right now that need to be treated before taking care of the rest of the patient. We want to make sure that we maintain that privacy throughout the interaction. So ideally, we want to make sure that there's a private space for that patient to wait in. So either while they're waiting maybe for a forensic nurse examiner or sexual assault nurse or another healthcare practitioner who's going to take care of that patient, see if you have an area in your facility where they can sit in a private area and have confidential care. We also want to make sure that we maintain that patient's confidentiality just like with any other patient. So we only want to be sharing what information medically we need to share with the healthcare providers that require it, and we're really maintaining that confidentiality for that patient and that survivor. And we want to make sure that we're offering options and we're providing information. So we don't want to assume when a patient comes in on what care they want or they need, we don't want to assume that they want law enforcement involved. And instead, we want them to be the driver of that. So we want to let them know what our role is as a healthcare provider, what their options are today, and provide them with all the information so that they can make an informed decision. So now I just want to talk about some of the principles of trauma-informed care. And obviously, this is a much wider topic that we can focus on. But for the purposes of today, I'm just going to review some basic concepts. But this is an area that is really important as healthcare providers, that we get additional education and information and training on to make sure we're providing patients and survivors with the best care possible. So some of the principles or hallmarks of providing trauma-informed care are giving choices, allowing our patient to have control from when they walk in the door. So giving them information about what are some of the things we can do for that individual today. So hi, Jane. My name is Ashley. I'm one of the nurses that works here at the hospital today. I'm so sorry to learn what has happened to you. And I want to start by letting you know that you have complete control over what we do today, and what care you receive. And then I might go through some of the options they have for care, or I might ask that individual what they are most concerned about first, or what questions they may have, but I want to make sure they know that they have control throughout the process. And if at any point they want to stop, they have questions, or there's part of the process or exam that they don't want to do, they don't have to do that. I also want the patient to know that they are believed, and I want to make sure we and I are conveying a non-judgmental attitude. So I want to make sure that patient knows, you know, I believe, I believe you, and we're here to provide whatever care they need, and support them throughout that process. It's important to maintain eye contact and avoid distraction. So I want to make sure while I'm treating that individual and seeing them that I'm not distracted, maybe on my computer, or I'm not distracted with something else informs and while I'm asking them to tell me what happened, or I'm giving them information, I want to make sure I'm giving them my undivided attention. Again, I want to convey a non-judgmental attitude. So I want to make sure that I am not my aware of my body language, my facial expressions, I'm not sitting with crossed arms, and that I'm prefacing any questions I might need to ask as well. So the patient doesn't feel that they're judged for some of the things that I might be asking if they have a medical or even a forensic basis to them. Being aware of our body language. So again, you know, what are your facial expressions? What is your body language? Is it closed off? Is it open? Are your arms crossed? Where are your hands? Can the patient see your hands? Are you blocking the door? Are you creating an open environment? What is the tone of your voice? And even looking at the environment around you, depending on what setting maybe you're practicing you're working in. So if it's in a busy urgent care emergency department, is there a lot of overhead page and you're yelling going on? Is there a quieter space that you can go into, where you can allow for that change in environment? Who else is in the room? So making sure again, we have privacy, and we're talking to individuals by themselves to allow them the opportunity to share without maybe a friend or a caregiver present. And making sure if we have access to advocates, that we're offering those services well and making sure that patient has access to that. It's also important to reassure the patient that what happened is not their fault. We want to make sure that we convey that we're not blaming them, that this is not something that was in their control, and what happened to them was not their fault. It's also important to allow time for patients. Sometimes in our healthcare settings, we get in a pace that goes very fast and we are used to speeding up and getting things done as quickly as possible, especially if we're in maybe a hospital or an emergency or an urgent care setting. It's important to allow time for our clients and patients to ask questions and to stop and ask them throughout the visit, do you have questions about anything? Is there anything I didn't explain enough? What would you like more information on? And it's important as well that we just allow time and sometimes time for silence, and we don't rush the process for individuals. So just kind of being conscious sometimes on even the speed maybe of how we're talking and explaining things, taking natural breaks and pauses when we're talking about some of the options of the exam and asking the patient, you know, do you need a minute to kind of sit with this information? Are you okay if I keep going? You know, does this feel overwhelming right now? And just checking in and slowing down if that patient needs to. It's also okay to tell that patient that they don't have to decide right now and then what kind of care they want. If a patient needs to sit with their family or their caregiver or their support person for a little while or come back later, that is their choice as well. It's also really important when we talk about trauma-informed care to explain what we're doing before we proceed with anything. So this goes with any kind of medical procedures or examination that we're going to do, but even when we're maybe going to ask some questions about the medical history or what happened to somebody, it's important to explain before we do something. So you know what, the first thing I'm going to do is I'm going to ask you some questions about your medical history. If there's anything you're not comfortable answering or you wish for me to stop and you need a break, just let me know. The other thing that's really important is that we keep our patients covered throughout the exam as well. So we are keeping patients clothed and covered as possible, using a blanket, a sheet to keep them covered, whether they're in still their own clothes or if they're in a hospital clothes or gown. We want to make sure they're covered and they don't feel more uncovered and that we are giving them the option to do things for themselves when they can. So for example, if I want an individual to uncover their arm because I want to take a look and assess their arm, instead of me pulling back the blanket or their gown, I want to give them that control. And I would say, hey Jane, do you mind if you just lift the sleeve of your gown up? I just want to take a look and I'm just going to feel their palpate the outside of your arm. Or can you just lower your gown briefly for me? So we want to make sure we're asking patients to do what they can do for themselves versus us doing to them and explaining what's going to happen before we do that. So when I ask you to lower your gown, I'm just going to briefly be looking for this or you're going to feel me palpate, touch your arm to see if you have any tenderness or any soreness there. So we want to make sure that we are giving that control and giving those options throughout the entirety of the exam. It's important as well to make sure we recognize what the priority is of our examination. So our priority, even though we're talking today about forensic evidence collection, that's not the priority when we go in to see our patients. Our priority as healthcare providers is that patient's healthcare holistically, right? Their physical health, their mental health, their emotional well-being, and making sure that we're having patient-centered and patient-driven care. We want to make sure that our care is also culturally safe. So making sure that we're working with other multidisciplinary team members and that we have an awareness of our unconscious biases and other cultures within our community. So we are providing the safest and the best care that we can possible to that individual. It's important to be aware of these things because things we do during our exam could impact that. So for example, if we are going to collect maybe someone's pad or tampon when they are having uterine bleeding or on their menses or on their time, in some cultures that might be seen as a very sacred time. So taking a pad or a tampon from them really might impact that, or cutting their hair might impact them, or who is in the room, or our level of eye contact. So being aware of what is culturally safe and for individuals will really help us understand what their care needs are and how we can adapt our exam as well. So what is our role as that healthcare provider? We have many different roles. So that first role is to provide that trauma-informed care and to give those choices and make sure it's patient-centered. Our goal is to do an assessment of an individual and to make sure they're physically and medically okay. So that may include a physical exam if an individual wants that, and it may include access to testing or treatment for sexually transmitted infections. It may include testing for pregnancy if your patient has a uterus, and providing emergency contraception to prevent an unwanted pregnancy if that individual wishes to have that as well. And then lastly, if an individual wants to involve law enforcement, which again is their choice, then our other role can be collecting some forensic evidence to assist investigators in investigating what has happened to them. But again, that is a patient choice. So now I want to briefly talk about some of the options for reporting after sexual assault. And it's really important that folks are aware of what some of the reporting options are in the jurisdiction that you're working with. So you want to make sure you're contacting your local law enforcement and your multidisciplinary team members and being aware of what your mandatory reports are. So one of the options when someone comes and sees us after being impacted by sexual assault is obviously to provide and have medical assessment and treatment, that should always be an option. And their other option is do they want to report to law enforcement or not, because it's not mandatory. The other option they can have is having an examination without reporting to law enforcement. And so in that case, you wouldn't collect an evidence collection kit. And that's providing that comprehensive physical and medical assessment and any testing and treatment that that patient may want. The other thing to consider that may be available in the jurisdiction that you're working in is does your region or your province have a forensic hold or anonymous kit option. So some areas may have this option where you may have an individual who's unsure if they want to involve the police or not. And some facilities may have the option to collect the forensic evidence kit and to store it for a period of time until that patient makes a decision to hand it over to law enforcement or not. Sometimes those kits then are held or frozen for a specific amount of time. Other areas may have what's called the forensic hold kit, where that information in that kit still goes to law enforcement, but a consent is signed so that law enforcement does not investigate that sexual assault at all. And they hold that sexual assault evidence kit in their evidence storage lockers without opening any investigation. And in some areas, they hold that kit for up to life until that patient decides if they want to proceed or not with it. And so that is a choice individuals may have or not. And it's really important to just check with your local law enforcement and your multidisciplinary partners to see what is available in your community. In some areas, if the assault was by an intimate partner and it is law enforcement that is holding that evidence, they might not be able to do that because they may not have they may have mandatory reporting guidelines. However, if it's a health care facility that is holding that kit for six months or a year, then they may be able to do that regardless of the of the details around the assault. So just making sure you're aware of what the options are in your community so that that patient and that survivor has the most information and the most options available to them. The other thing that's important to be aware of is what the age of consent is for sexual activity in Canada. So this is not age of consent for medical treatment. And again, look into that where you practice and what your mandatory report laws are. But this is the age of consent for sexual activity. So in Canada, the age of consent was raised from 14 to 16, which means someone legally has to be 16 years of age to consent consensually to sexual activities. However, there are what we call close in age exceptions. And you can easily find this on the Government of Canada website as well if you need to look it up and remind yourself. So individuals who are between 14 and 15, they can still consent legally to have sex with someone who is within five years of their age. And it says here a peer, so that means not a person who is in a position of trust or authority. 12 and 13 year olds, they may consent to sexual activity with a peer who is within two years of their age and again, not in a position of trust or authority. So what that means, even though the legal age for sexual activity, consenting to that is 16. There are some of those close in age exceptions that do apply. Anything that is considered exploitive activity though, or any sexual activity with someone who is in a position of trust or authority, that age is still 18. So those ages are just helpful to keep in mind if you have an individual comes in and maybe you have a 14-year-old who says, I'm having consensual sex with a 30-year-old, you know then that that is under the age of consent for sexual activity, and it falls outside that close in age region. So it doesn't mean that we force that individual to have a sexual assault done at all, right? We would never force that, we need consent and assent, but it may mean that it impacts your mandatory reporting guidelines. You wanna make sure you check in your jurisdiction who you mandatorily have to at least report that information to. So next we're gonna get into the RCMP sexual assault evidence kit. So what the RCMP sexual assault evidence kit is, is it is a standard sexual assault evidence collection kit that is produced by the Royal Canadian Mounted Police, and it can be used by healthcare providers across Canada. So depending on where you work or practice, you may, there's a variety of areas that will use the standardized kit. And it includes everything you need for the forensic evidence collection, and we'll talk about some of the extra things you may need as well. And it is also containing a lot of the documentation and the forms and the evidence packaging materials that you may need as well. These are some of the contents that are in the kit, and later on in our webinar, I'm gonna show you the contents of the kit live as well. So some of the things that are included in the kit are swabs that are required for evidence collection. So these are sterile cotton tip swabs that are used for different body type swabs, as well as maybe internal swabs for evidence collection. There are paper bags in there to collect clothings or other items that may be collected for evidence. There are breathable evidence bags, and those might be for items that might be a little bit damp or moist. There is a healthcare practitioner's guide, and that healthcare practitioner's guide is a good thing to pull out at the start of your exam, maybe before you go in and start examining the patient. And it is a really great instruction guide that tells you some of the contents of the kit, as well as how to do some of the samples and some of the evidence collection that is contained within it. It also includes all documentation you need for the kit, and that documentation goes with the kit and copies go with the patient's chart or with the healthcare provider where you're working as well. It also has evidence, which you place your swabs in after, and then those are sealed and placed back in the kit to be handed over to law enforcement. It also contains an evidence seal, so you can seal up the box securely when you're done. And there's also labels in there, so you can label your individual tubes, and you can label the evidence envelopes as well, so that everything is very concisely documented and labeled. And these are some of the images of the things that are contained in the kit. So you see the Healthcare Practitioner's Guide there. That is where there is a bunch of information in there about how to do some of the swabs and some general information on examining individuals and using the kit as well. The next one is a picture of the sterile cotton tip swabs that are contained in the kit that are used for most of the evidence collection. And then the last picture are some examples of some of the stickers and the labels that are contained in the kit that are used for the forms and the documentation, as well on the swabs and the envelopes themselves when you are packaging it. So each kit has its own identifier and number. Because there's some things that are not included in the kit, so speculums and anoscope. So if you have a patient where you need to use one of those, that's something that you will need to have and be able to access that's not included in the kit, as well as an alternate light source, and that might be used by an individual to detect body fluids that's not in the kit. The other thing in the kit might mention as well is called tolidine blue dye. And this is a dye that is an adjunct or an aid when you're assessing someone and assessing for injury. So it's not something that's used all the time or by every individual, but you may see its use mentioned in the kit, but it's not included in the kit. You also won't have any rulers or measurement scale. So when you're documenting any injury, it's important that you have a rule or a measurement skill so you can measure what those injuries are when you're documenting them. You will also need some sterile water and you use sterile water for moistening some of the swabs when you're doing some of the evidence collection. So that's not included. And the other thing you'll need is any supplies that might be warranted for testing for sexually transmitted infections and blood borne infections, as well as any medications for sexually transmitted infections and prophylaxis, as well as for emergency contraception. So those are some of the things that you may want to gather before you start the process, that you have it readily available to you and anything else that you just may need to assess that patient from a physical assessment standpoint. So how do we get access to RCMP kits? So in Canada, these are usually contained at a Royal Canadian Mounted Police or RCMP detachment. So depending on where you work and practice, you can find out where your local detachment is and you can get one from your local RCMP detachment or member. So you can call them up and let them know that you have a survivor and that you need access to a sexual self-evidence kit and they'll be able to bring you one. In some jurisdictions, the healthcare center might store a kit or two on site. So that they don't have to call police to bring one in if a survivor or patient comes to hospital or your clinic setting, but instead has one or two that they maybe always keep on hand. If you're doing that, it's just really important that you check the expiry dates on them and that you keep track of that so that you always have access to a kit that's not expired. If you are in a site and you don't have one, you're at a site and you don't have kit, you just contact your local or your nearest RCMP detachment and they should have one on hand that they can bring to you. The other thing I briefly wanna touch on and we'll talk about this a little bit later is a reminder about drug-facilitated assaults. So if you suspect that your patient either has encountered or they've disclosed to you that drugs or alcohol may be given to them during the assault, you also wanna request a toxicology kit that goes along with the RCMP sexual assault evidence kit. And in that kit is the documentation and supplies to collect blood and urine for the RCMP lab to do testing for drugs and alcohol. And so that is not contained in the main kit. It is something you have to ask that RCMP detachment for, is to say, hey, do you have a drug-facilitated sexual assault or toxicology kit as well? And it is a much smaller box and that is the documentation that you need and I'll show you the form later on, as well as the tubes for blood work and a container for urine sample. And then those samples and that information gets sealed in that kit as well separately and that also gets given to RCMP so it can be processed in one of the RCMP labs across Canada for toxicology. So next let's talk a little bit about when you first meet your patient and someone has disclosed that they've been impacted by sexual violence, how to introduce yourself and your role before getting into what some of the options in the kit are. So I'm gonna start off by saying hi, I'm Ashley and I'm one of the nurses or nurse practitioner or physician assistant or physician that works here. I'm so sorry this has happened to you. I wanna tell you a little bit about what we can do for you here today and then you can decide what you want. So I wanna make sure that patient knows that they have options in their care. The first part of my job is to make sure you're physically and medically okay. We can test you for infections and discuss medications to prevent those infections as well as prevent pregnancy. And another part of my role here is if you want to report to law enforcement, which is your choice, we can collect some extra information that police may use to investigate what happened to you. So I will explain those options and then see where the patient is at and say, do you know what any of these things or do you have any questions for me right now? Have you thought about reporting to law enforcement or do you have any questions about your health right now? And then that kind of began the discussion with that individual on what kind of care they would like today. And if someone feels like they are unable to make that decision right now, we can allow them some more time. I always also wanna make sure that they know the timelines for me collecting that forensic evidence. So again, that's one that you wanna make sure that's something that you have a guideline on where you're working. You can also connect with staff at the RCMP lab and looking and keeping an eye on what best practice is across North America and what we have in our field that says what best practice is for collecting forensic evidence and DNA. So that's what kind of guides what those timeframes might be. So I might tell the patient, here we can offer this exam and collect evidence up to this many days or hours. I wanna let them know that sooner is better, but even if they do come later, there's still a lot of things that we can do in care that we can provide them. So they know what some of those timeframes are to make that best decision. So we did talk about the consent for sexual activity, but I also wanna talk about consent for the examination. So it's really important that our patients and survivors have the ability to provide consent before we start any type of examination. So it must be given prior to examining evidence. We cannot proceed with a sexual assault examination when the patient isn't able to consent or they're unconscious or they don't have that ability. We also cannot have another healthcare provider consent on behalf of that patient. This is not a circumstance as it is considered emergency medical treatment. And a patient always has the right to decline an examination. Even if they're an adolescent, we're not gonna force someone to have an examination. So even if we have mandatory reporting laws that impact the patient we're seeing, we're still not gonna force them to have any type of physical exam for evidence collection. Sexual assault evidence collection also shouldn't be done if the patient is under the influence of drugs or alcohol. And this is not something we determine by testing. So we don't determine that by a blood alcohol or drug testing, but it's by my assessment of that patient. So do I feel based on my assessment that that patient is understanding what they're consenting to and what this exam is part of? Can they stay awake and talk with me? Can they carry on a conversation? Can they describe to me what it is that we're going to do? So making sure that they can consent for that examination. So that's not to say if someone's come in and they've had one or two drinks that they can't consent. Again, it's based on your assessment as a healthcare provider. Does my patient understand what we're doing? Can they carry on a conversation with me? Are they able to stay awake? Are they unconscious? Are they intubated? Are there some cognitive concerns that make them not able to consent? If those processes are in place, we also wanna make sure we have a policy or guideline that guides us when we have a situation where the patient can't give consent. So for example, if someone maybe is unconscious or they're intubated and they're expected to be for a significant amount of time, do we have a guideline in place to say who then can consent on their behalf? And what does that look like? What is that decision-making and those conversations with that decision-maker? Or are we waiting till that person regains consciousness? If someone has a cognitive impairment, what is our guideline or practice in that circumstance? How do we get consent? So those are some important conversations to have in the area that you are working in and to make sure you have a guideline, a practice guideline or a policy to help guide those decisions as well. It's also really important to remember that although this exam may be urgent, it's not emergent. So their healthcare takes priority. So if an individual has other medical concerns going on that are priority, those should take precedence and be treated first. And collecting forensic evidence is secondary with that person's, you know, their medical state. So we wanna make sure we're taking care of them medically and physically first, and especially treating any emergent or urgent medical issues. We have time to collect forensic evidence. So it's not something that's going away right away. We have time to work with, and again, that patient's care and their choice is what matters the most. So what do we do if a patient chooses not to report to law enforcement? Well, there's still a number of things that we can do. We wanna make sure that we're still giving them that same trauma-informed care, that we're offering medical care, a physical exam or evaluation if they want, as well as testing and treatment for sexually transmitted and bloodborne infections. We wanna make sure we're providing prophylaxis for some of those sexually transmitted infections, such as gonorrhea, chlamydia, hepatitis B, and syphilis. If you're within those timeframes for prophylaxis in your area, some jurisdictions may also provide prophylaxis for chikungunyus or testing for that as well. And if you have a patient who has a uterus, you wanna make sure that you're offering them emergency contraception if they're in that timeframe as well. So you wanna make sure you know what options are available, where you're working and practicing, and make sure your patient has access to those. You wanna be offering hepatitis B and HPV vaccination if that's available to you, and make sure that your patient and that survivor has resources for follow-up. So that's both medical follow-up, that post-exposure follow-up, how they can access the test results for the medical testing that you've done, as well as follow-up support and counseling so that they have access to that when they're ready as well. So again, holistically, we wanna make sure we provide that. It's also important that we do some safety planning so that we're conducting a suicide risk assessment and that we're making sure that patient has a safe discharge plan. So where are they gonna go after discharge? Do we need to help with some safety planning or have another provider involved that might work with us? Do they need access to anything else, to shelter, access to help pay for medication, and making sure that we're doing a complete assessment before we discharge that patient? It's also important that we give patients information when we discharge them as well on some of the medications and the testing that we did so that they can refer to that after. So next what we'll do is we will get into using the RCMP Sexual Self-Evidence Kit and its content and go through some of the how-tos on using that kit. So before you begin, you wanna make sure that your patient is able to consent. And if not, you wanna then follow your processes or wait until they do have the ability to consent. You also wanna make sure that you have a kit available to you. And so if you don't, you wanna make sure you're locating one and you're not starting until you have that part available. You might still start with maybe some other blood work or some of that medical testing, but you wanna make sure you call and you get access to that kit as soon as possible. You also wanna ask if your patient wants a support person or advocate if you have one available. So asking them, can I call someone for you? Is there anyone that you would like me to call to be here with you? And you wanna look at what space you're gonna do the exam in. So do you have a private space and do you have all the supplies you need? So I wanna make sure my room is ready, it's been cleaned and I have everything I need to so that I'm not interrupting the exam and going in and out of the room. Once I start that process, I wanna make sure I'm maintaining chain of custody and I wanna make sure that all of my supplies are in the room with me as well. It's also important that law enforcement is not present during the examination. This is not a requirement. We're gonna talk about maintaining chain of custody and instead you would sign that evidence collection kit over to them after the exam or when they're available to pick it up. First things first is signing the consent. So before you start the examination, I'm gonna explain to my patient, before we go through some of your medical history and briefly discuss what happened to you today, I am gonna get you to sign a consent and this consent allows for me to do this examination on you and collect some of the forensic evidence and give that to law enforcement if you still wanna proceed with that. And so I will fill that out and I will read the consent to the patient and give them the opportunity to read that consent as well. You can see in the top right corner of that is a kit reference number. So that sheet of labels with the numbers that I showed you earlier, that is where you would place one of those stickers and each kit has its own set of identifiers that you will get that has its own sticker number on it. So they would look something like this. And so you would just peel off one of those stickers and put it in the corner and that's something that's gonna go on that spot of all the documentation as well as the date. Once you get through this form, so you're gonna put your name on it, the survivor, your patient's name and at the end you're gonna sign it as well as a witness as well. The next thing I'm generally gonna do is obtain a medical legal history. So I wanna make sure my patient knows why I'm asking some of the questions that I'm asking and make sure they know that we can stop at any point in time. So the purpose of this is to help inform our assessment and our examination of the patient. So just like in any other medical assessment assessment or setting, I want a history before I start my examination. Our history should be objective. We have bias judgment as well as our own perceptions. And we want to make sure that we're only asking what we need to do our examination and collect forensic evidence if we need to. So we're not investigators. Some of the things that I'll consider before I start the history is what is the environment? Am I in a private area with a closed door that the patient has privacy? How is the patient right now? Are they comfortable? Are they covered? Are they okay to continue going? You know, have I explained to them, you know, what we're going to discuss next? What is my body language? Am I standing over the patient? Or am I sitting on the same level as them? You know, is my patient in pain? Are they really uncomfortable? If they're in a lot of pain or uncomfortable for other reasons, it's going to be difficult for them to be able to participate and engage with me in the history. So let's look after that first, right? Are they really nauseous? Are they are they having pain? Are they uncomfortable? It's really important to note, and this goes back to when we were doing education and talking about what our triage processes might be. So there as well as you know, when yourself as the examiner is, is examining that individual is remembering that when they're telling you what happened, this might be the very first time that they have said those words out loud, or told anyone. So it's really important to be aware of how difficult that may be. And to allow that patient time and to make sure that you're providing you know, the best care that you possibly can and using those trauma informed care techniques when they're providing you that information. It's also important to be aware that the patient may have already told their story multiple times. So part of being trauma informed as well, is avoiding having people recount their details, and retelling their story over and over. So being aware of that, have they already talked to police, triage, an advocate, a friend, and I want to make sure I tell individuals the reason I'm asking some of this information. So I might say, you know, I'm going to get a little bit of information about your medical history, so I know how to care for you and treat you. And then I'm also going to ask a little bit of information about what happened to you. And the reason I'm asking that information is so that it can help inform what type of assessment and examination I'm going to do on you, where I may need to look on your body or look for any injuries. And it might also assist me in where I might decide to collect forensic evidence, just so that they know, they don't have to feel the need to tell me all those details. But I will still remind them if there's anything that they don't want to answer, that that is totally okay. And they can just tell me that. It's also really important to reassure patients that it's okay if they don't recall some details. And it might be multiple reasons that they don't remember what happened to them. It could be because they were unconscious because of a drug or alcohol facilitated assault, as well as just the impacts of neurobiology of trauma. So just letting patients know if there's certain parts they don't remember. But that's, that's okay, if you don't recall that right now, so that they don't feel pressure to remember those details and tell you all of them. The next part of the form is called the sexual assault interview. And this is the form that's included in the RCMP sexual assault evidence kit. So you will see that kit reference number in the top right corner again, where you were put that. And this is some of the information and some of the demographics about that individual. So what is their name, you will see then gender is under there. And you will see right now in this form, we only have two options for gender male and female. So it encourages you to make sure we're also providing gender inclusive care and asking patients how they identify Can you let me know what your correct pronoun is, just like if I'm going to ask them their name, you know, someone says, Oh, my name is Jane Doe, what would you like me to call you today? What name do you go by? And what pronoun? What's your correct pronoun? Or I might start by introducing myself. My name is Ashley, and I use she her pronouns, what what name and pronouns can I use with you? So you can just write that date of birth is there. And then the date and time of when you're asking some of this information that anyone accompanied them. And if someone accompanied them to hospital, and they're in the exam room with you, you want to specify their naming relationship. So yes, patients, mom, Judy, general appearance, I've written in something an example in here. So we're doing general parents kind of how they're presenting on a good reminder on any of these forms as well as if there's something that you feel like is not applicable, or there's something that you don't have to write in there, you don't have to fill all of that space. So here, I might say alert oriented or alert narrated times three person place time, I might make a comment here, if they've come in and their clothing is covered with grass and debris, that's information that may impact the investigators or their lab, and there may be processing some of their clothing. When we go down to emotional state, again, we want to be descriptive, we want to be objective. So I might say, patients affect is blunted, often looks down, or covering head with blanket while discussing assault, started to cry when discussing details of assault, talking through tears, wringing their hands. So again, being descriptive about how that patient is appearing in their emotional state. And we don't have to feel like we need to use all the space in here, if you don't have more to write. The next section is the details of assault. Again, here, we want to be concise, and we want to use the objective, we want to use the patient on the patient's own words and quotes when it's relevant to do so. And just remembering what our role is, again, as healthcare providers, and we are not investigators. So we're not trained in that way. And that's not our role. So I might state something fairly concise here, like patient states, awoke to no male vaginally, sexually assaulting her, you know, without condom, or just like that. Or I might say, patient has limited recollection of events awoke to person on top of them, him, her. So you can be as brief as you want, you can write more, but again, you don't have to feel like you need to fill the whole space. It's remembering kind of what our role is, is that healthcare provider. And if that patient doesn't want to discuss and tell us a lot of what's happened, that's okay, too. And I may just write in here, I might just put a line through and initial it. Or I might say, patient has already spoken to law enforcement does not wish to discuss details again. And that's also completely appropriate. And then we're going to sign and we're going to date and we're going to time that at the end. Next is a sexual assault history. And this is more of the details of what happened during the assault. So after I've done my medical history, that's when I will usually say, I'm going to ask you a little bit of questions now about what happened to you. And backing up a little bit to the medical history. So genetic medical history, like we would in another circumstance. So you know, are you on any medications? What's your age? Have you ever been hospitalized? What's your immunization status? We want to be asking some of those questions. You know, do they have any pain or bleeding anywhere? So once I've done that part, then I'm going to say I'm going to ask you some questions now about what happened to you. And the only reason I'm asking so I know where to assess you, how to examine you and where to collect forensic evidence if we're going to continue doing that as well. And reminding the patient if there's there's, you know, pieces they don't want to answer, or they don't know, then that is perfectly fine as well. So for the sexual assault history, you'll again see some of the same things with the patient's name on the top and their gender. So you want to write in how they identify and the kit reference number as well. So you want to make sure those identifiers are on the all of your pages. The first section is really important that we read that carefully. It is asking about prior to the assault, did any of the following sexual contact occur? And so before I ask some of these questions, I want to make sure that I preface these with the patient so that they don't feel judged. So instead of just saying, did anyone perform oral sex on you in the last 24 hours, I want to make sure that I'm saying I'm going to ask you some kind of odd questions right now. And they're asking about your sexual activity within the last seven days, so that the lab might know if there's, you know, more than one DNA profile on you. So we don't care, you know, if you've had sex with anyone else, but this is some of the reasons we're asking. And so we want to make sure we preface that so the patient doesn't feel judged. And we don't just go right into that, that information. And then I can go into it a little bit. And I usually will only ask what is relevant as well. So if the patient is here, because they were only not only but they were rectally assaulted, and there was no other contact, I don't need to be more invasive and ask them if anything went in their vagina, if they have a vagina, or if there was any contact with their genitals, their vulva, their penis, or any contact on their mouth. So if that's not relevant, I don't need to ask that information. So I only want to ask what's relevant. If the patient says, I was vaginally sexually assaulted, I might say, is there anyone else that you had any vaginal sexual contact with within the last seven days? And it's just a yes or no, you don't have to write who that was with. And then you just want to ask if there was a condom used or not. And if the patient is unsure, you can just write an unsure. So again, making sure you're reading those questions carefully before you go into them. So you know what they're actually asking. So was their oral performed on the patient within last 24 hours? Was their oral performed by the patient? So was anything put in the patient's mouth? Was there any rectal contact or sex within the last three days and then vaginal sex within the last seven days? Then it goes into the assault location. So again, I might say, you know, and this might change a little bit how you go through these questions. If the patient has already given you some of this information, I don't want to repeat it. So if the patient already told me earlier in our interaction, they were assaulted at their home in their bedroom, then I know the assault location. And I will just say at patient's home, in bedroom or in living room, or at perpetrators or assailant's home. And then it asks for the date of assault and the time of assault. One thing to really keep in mind here when we're going through the date and the time of the assault is to be aware of the time of day it happened, especially as we get close to midnight. So someone might say it would happen last night. And so I'm thinking, okay, well, this is the day that happened. But maybe last night meant early morning. So it was two in the morning. Well, that might change my date. So just making sure we're clarifying that and then the time. And if the patient doesn't know the exact clock time, because that might be really difficult for that individual to be able to recount. And again, I'm not an investigator. So knowing how to verify that I might just put a little bit more generally, I might say happened in early morning hours or evening hours. You know, especially if my patient doesn't know, like it's exact time, I think, you know, that is fine. The next question on here is, was that patient's debate the patient changed a clothing? So just yes or no. And if they did change a clothing, are they available? And so then I might let them know, they say, oh, I changed my clothing, but they're at home right now. They're unwashed. I might say, okay, when we talk to law enforcement, make sure you let them know that they have that clothing. And then they can go get it from you, or you can bring it to them. Or if the patient gives me permission, I may tell law enforcement that. And then they will ask, you know, have the clothing been washed or not? If it's not been washed, I just remind the patient, you know, when you go home today, maybe just don't wash them, put them aside, or I might give them some paper bags to put that clothing in until they connect with law enforcement and decide if they want to give those clothes or not. If your patient has a uterus, you also want to know, you know, were you bleeding at the time of the assault that was from your menses? And the next question is, how many people were you assaulted by or was that unknown? If the patient doesn't recall that, then you can just say unknown. And again, sometimes this is information that will come out as part of the history. So you don't feel like you have to go through all this question by question. As you get more comfortable, it's probably more natural to have more of a discussion with the patient and say, do you mind telling me a little bit about what happened to you yesterday? Or you might start and say, you know, I'm just going to go through a few questions of what happened. You let me know that it was one individual that assaulted you, you identified that it was one male individual, was there anyone else present? So you just might go through and clarify like that. It also asks the gender of the assailant. So again, this is where you can write in if someone doesn't fall within that male-female binary, you can say identifies as non-binary, and then you could write in sex assigned at birth, because that might impact the DNA profile that the lab might be looking for. The next section on here asks, did the patient injure the assailant? And again, sometimes this feels like kind of a funny question to ask. So it's really important that we read it first and know what we're asking the individual. And I want to preface this question as well. So what I'm being as trauma informed as possible. So I might say, I'm going to ask you kind of a funny question right now. And I want you to know that in in most situations, it is our our instinct or survival instinct to just kind of freeze and protect ourselves by by not doing anything. At any point, do you think you left any injuries or any marks on that person? So I just want to know if the patient says, oh, yes, I scratched them, or I punched them or anything like that, then we would document it there. And if your patient didn't, that's okay, as well. And making sure you're acknowledging that and prefacing why you're asking that so your patient doesn't feel judged. And then they're not self blaming, like I should have done more. So you want to make sure you're responding to that. The next section is what is the relationship of that suspect or that assailant to the patient? Was it someone known to them? Is it a spouse, a family member? Is it acquaintance? So we're gonna want to write in there as well. And then the next section is what acts occurred and were forced on that patient during the assault. So there's a rectal contact was their contact that patient's penis, vagina, bum, rectum, their mouth, and that's what you're going to write in there was any milk placed on their genitals. That's where you're going to write that information. Was a condom used and did that person ejaculate? And so that is other information that you're going to fill in there. If the person says yes, they did ejaculate, then I would ask them, do you know where they ejaculated? Was it inside? Was it somewhere externally on your body? Because that might be important for the lab to know when they're reviewing this form, but also you as the examiner, if you're going to swab that area as well to take a sample of a body stain there. And then one of the last sections on here is asking the patient what activities they've had since the assault. This is kind of pertaining to things like baths or shower or washing their body. And it's important to keep in mind that even if someone has bathed or showered or washed, it's still really important to collect evidence if that patient wishes to have that. We can still collect many great samples, even if someone has washed or has showered. So you just want to ask and if they have, you want to check that off. Same if they've had consensual intercourse. And then at the bottom of this, again, you're signing and printing your name and you were dating and your timing when you're collecting this information as well. So next we'll get into collecting the RCMP kit and using some of the evidence collection in there. So we want to make sure that we are collecting according the history of the assault. So it's important to remember that we don't have to collect everything that is included in the kit. You don't have to use everything in there. And anything you don't use, you can discard or you can recycle, but you don't have to put it back in the kit. You want to listen, make sure you listen to the history and you collect where you think that biological evidence may be left behind, right? So if patient says that individual had their mouth on my chest, then that might signal to me there might be some DNA on that person's chest and I might swap that area. We're going to collect blood and urine for toxicology. If you suspect a drug facilitated sexual assault, your patient suspects it within 72 hours. And we're going to collect systematically as we go throughout our examination, the physical exam. So we want to make sure we're not jumping around. So if I am, you know, done my history, and now I'm doing the physical examination, and I'm listening to the person's chest or lungs, and I also feel like I need to do a swab of their chest for biological evidence, then I'm going to do that at the same time. So I'm not jumping back and forth. So after I've done the consent, the history, medical history and the history of what happened, I'm next going to do a physical exam. And in general, I'm going to do a head to toe physical exam if that patient is okay with it, I want to do a comprehensive exam. This includes a description of that patient demeanor that goes on that exam form, and doing a good overall assessment. So looking at their head and neck, if someone discloses that they've been strangled, and I'm going to do obviously a little bit more of a focused head and neck assessment, or they've been hit in the head, I'm going to do a little bit more of a head and neck assessment and neurological assessment. And I'm just going to be doing a complete assessment on their extremities and their body assessing for any normal variants or any injuries that I might see as well. I'm going to document any injuries I go and in the kit as well, you will see access to chromograms that you can use, and body diagrams that you can document what you're seeing. When you are doing that, you want to make sure that you are documenting concisely, you are documenting measurements, if you have a measurement scale, as well as the color and location of those as well. So you might document any bruising, lacerations, abrasions, bite marks, or any pattern injury as well. It's also really important that we don't date bruises. So this is an area that we, you know, have a good amount of research in. And there's not research that's suggesting that we can determine the age of a bruise by the color of it. So that's not something that we need to put on those traumagrams or documentation, but just simply describe what we're seeing. So two by three centimeter blue bruised upper right arm, tenderness and palpation. It's also really important that we wear gloves while we're going through as well, and we're changing our gloves frequently, similar to practices of infection control. We want to make sure that we are not transferring evidence all throughout the body or contaminating it by touching, you know, a dirty surface or talking over our evidence or coughing or sneezing over it or anything like that. So again, as we're going through, we want to make sure we collect as we go systematically that we're collecting according to our patient's history and the history of what happened to them. We always want to make sure we're changing, we're wearing gloves and we're changing them frequently, washing our hands in between. Even when we're doing the palpation of the physical exam on someone's arms, we want to make sure we're wearing gloves at that point as well. So we're not leaving our DNA on them, or we're transferring things. And we want to make sure we're not cross contaminating as we go through the kit as well. Okay, so now we'll go through some of the RCMP kit components. And we will go through how to utilize some of the swabs and some of the samples in there as well. So one thing to keep in mind when we're doing this is Locard's Principle. Locard's Principle is when a person or object comes into contact with another person or object, there exists the possibility that an exchange of materials takes place. So keeping that in mind when we're going through the exam and going through what we might be collecting. And these are some sources of DNA that we might utilize and we might collect. So we might be collecting some trace DNA evidence, so maybe there's a hair on the body. We might be collecting a sample that contains semen. We might be swabbing something that might be more touch DNA, saliva, there may be blood and there might be sweat. So these might be some of the things that we're collecting during the process of our examination. The first thing I'm going to talk about is clothing. So in the kit, when you open it up, and I'll show that to you shortly, there are some brown paper bags that you can collect clothing in. And so this is a discussion with your patient, but also being aware of those principles of evidence collection and transfer of what clothing that we are going to collect. So clothing should always be packaged separately, individually. So we don't put multiple clothing items in one bag. And if it's wet, it should be dried first. And we're always packaging those things in paper bags as well. So it wouldn't freeze on plastic. If any of the clothing is damaged or stained or ripped or has blood on it, we want to make sure we're documenting that as well. We want to document what is in each bag as well. It's also important to collect underwear often, that's often a good article to collect. Even if it's after the assault, maybe a few days later, underwear can be an article of clothing that can be a good piece of evidence to collect and to send to the lab. The other thing you can use is drop sheets. And so the kit contains drop sheets. And that is a paper sheet that when your patient is changing into a hospital gown, they can stand on that sheet and any debris that might be on them when they're changing can be collected in there. So we'd have the patient maybe stand on that sheet, and I'd have them change into a gown. And then I would package their clothing off of that sheet into individual bags, whatever we decide we're going to collect. And then I would carefully fold that drop sheet back up. So it still contains whatever items might have fallen on there. And then that is packaged in the provided envelope as well. Even if clothing is washed, even underwear, some studies have found it can still have DNA on them as well. So that's why it's really important to still consider collecting those items. So for fingernail swabs, this may be something I may choose to collect if the patient describes having scratched the person at all, the suspect or the assailant. Or if there's a history of strangulation, that patient's instinct might have been to remove that person's hand off their neck, and they may get some of their cells or epithelias underneath their nails. So if we're going to do that, there is an envelope in the kit that I will show you that says fingernail swab, and it contains two envelopes. So one is swabs of right fingernails, and one is of the left, as well as cotton tip swabs as well. So using the swabs provided, you would moisten half the swab with sterile water, and would use the one swab for one hand, so you would swab underneath each nail with that one swab with the damp side, and then go over it again with the dry side, and then package it in that corresponding envelope. So you put the swab back in its container, back in the envelope, and seal it. And then you would take the other swab and do the same thing for the left hand. The other thing you may collect that's in the kit is an envelope that says trace evidence or foreign body. So this could be a number of different things. There might be some matted hair that you might think has some fluids in it. So with that, you could cut it out with some sterile scissors, or you could swab that area, and you would place that into the bag or the sterile container provided. You might find a hair, maybe in the vaginal vault or in the rectum. You may find stains on the skin that may be swabbed as well, or you may use and collect a tampon or a sanitary napkin, a pad or a condom. Sometimes the patient has come in wearing those, and I might collect that tampon or that pad, or I might find a tampon or a condom inside the vaginal vault, if I'm doing a vaginal exam, and those might be collected as well. We'll talk a little bit more about stains on the skin as we go as well, as well as combing for pubic hair. And again, we're going to collect if the history the patient has given us relates to collecting one of these things, right? So again, if my patient has no pubic hair, I'm not going to run that comb through there, or if they have no tampon or pad, I may not do that. Same with the matted hair. Anything that's wet, it's important that we package in paper or the breathable evidence bags as it's in there as well, so we don't degrade or mold any of that DNA. So some of the other type of body swabs that we might use, again, sometimes in the kit, you will see those labeled as body stains. Those will be, again, swabs taken according to the history and the exam. So it might be an area that the patient reports being ejaculated on, or that person have their mouth on their body. I might then swab that for saliva. Or maybe a patient discloses that they were strangled. I might then do a swab of their neck. Or they report someone, you know, holding down their wrists. I might do a swab of each side of their wrist, so swab of right wrist, swab of left wrist, anywhere they've been held. I might swab a bruise or a bite mark or a stain I see on the skin. So those are some of those other types of body swabs or stains that are in the kit that I would use one of those sterile swabs for. Sometimes you might have an individual who doesn't recall what happened. And then that examiner may choose, with discussion of the patient, to swab what we call high traffic areas. So that could be the chest or breasts, the neck, you know, the external genitalia, you know, vaginal, rectal, or penile swab, things like that. So we'll talk about how we do some of the swabs now. So we're swabbing a dry area of the body. So for example, maybe I'm going to swab the patient's chest because they recall the person's mouth being there. That area is now dry. So using one of the swabs that says body stains and those envelopes, I'm going to take out that sterile cotton tip swab. And I'm going to moisten half of it with a couple drops of that sterile water. And I'm going to swab it over the surface. And then I'm going to turn it over and swab it with that dry side. And then that's going to go into my evidence envelope, and I'm going to label it. We use that moisten swab for a dry area when I'm also swabbing the external genitalia. So maybe a swab of the vulva, the penis, perianally, a neck, a bruise, any area that is dry already, I'm going to use that moisten swab technique. And there's instructions on those envelopes as well, if you're going through and you forget that that benefit area should be swabbed with a dry swab or a moist swab. Now if we're swabbing an area that's already moist, so usually this is inside the mouth, the vagina, or the rectum, that area is already moist. So we're just going to use a dry swab. So we're going to find that corresponding envelope, we're going to take out the swab that contains that, and we're going to swab that area without having to utilize anything else on that. Some of the envelopes, one of the envelopes will say external genitalia swabs, and there's another one that says anal swabs. So external genitalia is when you're swabbing, you know, the vulva area. So the labia majora, menorah, that posterior foreshad, and that's going to be the moisten swab technique. So this will be a double swab, and it will show you that on the envelope, where we're going to moisten those swabs with some sterile water, and we're going to roll those swabs over that area. If you're doing a anal swab, that's saying that's that outside of the anal area, those perianal folds, we want to make sure we're swabbing that area as well with a swab that is moistened with sterile water. An oral swab is a swab we might do when we think there has been oral contact, so they have inserted something inside their mouth, and that is a double swab as well, and that area is already moist, so we can use a dry swab. So we're going to run those dry swabs along the gum lines, behind the incisors or molars, and inside the upper lips, and maybe along the cheek. Generally we'll do that if it's within 24 hours of penetration, and if the history dictates that. If someone has a vagina, and there's been vaginal contact, this is also a double swab, so we will take two swabs out that is contained in that corresponding envelope. Again, that area is already moist, so we don't need to moisten those, and we're going to swab the vaginal walls, across the cervix, and underneath the posterior fornix, and usually that's going to be done through the speculum, so it's going to be done as well before you do any of your medical swabs, but if you're in a situation where a speculum is not warranted or needed, or your patient doesn't want one, we could do what's called a blind swab, where I would part the labia, and insert the swabs in between the labia, into the vagina, and do what we call the blind swab. Rectal swabs are another area that I might do if my history denotes having to take rectal swabs. With a rectal swab, I want to make sure I'm swabbing past the dentate or pectinate line, and so for that, I need to make sure that I get some anal dilation. So with loved hands, after I've done my anal swabs or perianal swabs of the anal folds, I want to make sure I'm applying pressure to each side of the buttocks, near the anal opening, until I see it dilate, if I'm not using an anascope, and then I want to make sure I'm using that double swab, and inserting past the anal opening, past the dentate line, and I want to rotate and withdraw those swabs, again, doing that before my medical testing. If you're in a setting where you use an anascope, then you would do that, obviously, through the anascope. Bite marks is another area that I might swab, so if someone has some bite marks, I want to use a moistened swab, because that area is already dry, so I'm going to use one cotton tip swab, and I'm going to moisten it with some sterile water, and swab it with that moist area, and then roll it over, and swab it with that dry area. The other thing contained in the kit is called reference DNA, and this is a sample of the patient's known DNA, so we have a known sample, and that's done using a buccal or a buccal swab. So what you want to do is have the patient rinse their mouth out with water twice, or swish with water before collecting it, and again, if you're doing any other oral samples for the suspect's DNA, you're going to do that first, then have them rinse their mouth and do that known sample of the patient, and you're just going to take the one cotton tip swab and swab the inside of their cheeks, their teeth and gum, or they can do it themselves if they prefer, and then we would package that swab accordingly as well. So after you've done the physical exam, and you have gone through some of the evidence collection, you want to make sure then that you are discussing prophylaxis and that follow-up with the patient that we discussed earlier, making sure that they have a provider to follow up with, as well as some of those community supports, and some of those crisis services as well. I briefly want to talk a bit more about the drug-facilitated sexual assault. So this is what we mentioned earlier, if you suspect this or your patient does, you want to make sure you have access to the sexual assault, drug-facilitated sexual assault kit, which is a smaller box, and it contains the form and the supplies for toxicology testing. And generally, this is something we collect and the lab would accept within 72 hours of the assault. Within that kit are two forms as well, so one is the instructions on how to collect the blood and urine, and then another is some information. And this information, it's really important that we also preface to the patient why we are asking this information. So especially we want to make sure they don't feel judged, if they have consumed any drugs or alcohol, that's okay, it is just helping the lab be able to narrow down what they are testing for. So before I pause and I show you all the contents of the kit, this is a high-level process of doing this exam. So going in and introducing ourself and discussing options and obtaining that consent, doing a medical and a history of what happened, doing that head-to-toe physical exam, collecting evidence and documenting the injuries along the way, doing a natal genital exam, depending on what anatomy and body parts your patient has, and then packaging our kit, securing and either handing that over to law enforcement or storing it, and then providing your patient that prophylaxis and some of that other information that they need as well. So these are some additional resources that you can access as well, as well as my contact information if you have other questions that may come up. So now I'm going to show you some of the contents of the kit. So this is what the RCMP kit will look like. It will come wrapped in plastic, so it's secure, you know it's unused, and then when you open up the kit, this is where all of your information is contained. So one of the first things you will grab in there is this envelope that contains all of the forms and information you need. You will have the Healthcare Practitioner's Guide, which is a little bit of an instruction manual of how to do different things, as well as a lot of the documentation and forms that I showed you, and these forms are carbon copy, so they will say on there what copy the provider, the healthcare facility keeps, as well as which ones go in the kit for law enforcement. You will also see a Forensic Evidence Record, and so this is the sheet where you will check off what forensic evidence you've collected, because you're only collecting what is needed. You will see the first few lines, one A, B, C, D, or blank, so you could write something in there if there's something extra you've collected, for example, condom found in the vaginal vault or something like that. You also have some corresponding labels, and these labels go on the tubes themselves, and they have the kit number on there, and then the provider who's doing the exam, you would date and initial them, so for example, 7A and 7B are vaginal samples, so you would do your vaginal sample, and then you would put that sticker on, and then you have a sheet of the kit identifier labels as well, and these are the kit identifier labels that go in the corner of your documentation, as well as on some of the evidence collection envelopes as well, and then lastly, you have your traumagrams that we discussed, so on here are instructions as well as various different body maps. If you find any injuries, those are the traumagrams or the body diagrams that you can document those on. The other thing that you will find in the kit are various envelopes like we discussed, so for example, this one says clothing and drop sheet, and on the outside of the envelope will be the instructions on how to use that, and then inside will be the contents that you need, so for example, the one that says finger swabs, fingernail swabs on the outside of that main envelope will be the instructions again on how to collect it, so you can kind of refresh your memory, and then inside will be the corresponding envelopes, so this main one will be tossed after you read it, and one says fingernail swab right hand, and one says fingernail swab left hand. It also contains the swab that you need to do that piece of evidence, so for this one you have the sterile swabs for the fingernail as well as a sheet of paper, and you will notice on the envelope, and again you would have gloves on with a gloved hand, you would moisten part of the swab that you would have with sterile water, and you would swab that moistened part underneath each of the fingernails, followed by doing it again with the dry swab, and while you're doing that, you have this sheet of paper underneath in case any debris is collected, you would fold that up along with your swab, and you would label it, so I'm just going to show you that. So you would put your saline on there. When you're done and doing your swab, you put it back in the container. And this is where you then take off your label. That would say fingernail swab, right hand. And again, you have gloved hands on and you would place it on there. You have your initial and date you've already put on there and you would put it on there in the corresponding envelope. You would initial the envelope and then you would put your corresponding kit reference number label on the outside as well. And then I can go back in your kit. So that's what you would do with each of your swabs that you get. And so there's multiple different envelopes in here. This one is pubic hair combing. So what you will have in here is a fine tooth comb that has some cotton in it. And that cotton in it is meant to help collect any debris. You don't want to take the cotton out. And what you would do if someone had pubic hair, you would run this through once, the pubic hair in a downward motion. And then you would place it back in the envelope. Okay, and you would do the same thing. For body stains, there's multiple envelopes and multiple swabs in here because you might have multiple areas that you're gonna swab. So it could be a body stain, or it might be an area that you decide to swab like the wrist, the neck, the chest. It doesn't have to be something you physically see a stain on. Same thing at the dry area, you take the swab out, moisten it with a couple of drops of sterile water. And then what you're going to do is you're gonna swab that area with that moistened area first. So you're gonna swab with the moistened area first and then rolling over to the dry side. And then you're gonna package it, put your label on your tube. And then you're going to put that tube in your corresponding envelope. That's his body stain. And you have different body stain ones on here as well as some blank labels. So you could say swab of bruise to right arm or swab of right side chest or swab of neck. So you can do that as well. You have envelopes for your vaginal swabs, your oral swabs, you have external genitalia, which is your vulva, or you might use that for penis and strotum, anal samples, and then you have other items. So other items might be some of that trace evidence that we discussed. And you will have a plastic specimen container, but you also have these breathable evidence bags. So if you're using the breathable evidence bag, again, with gloved hands, placing the item in here, and then you're peeling off this label, and it's a self-adhesive. So if you peel this off and fold it over, it's going to seal, and your label goes on here. And then that all goes in your kit when you're done along with your finished documentation. You will also notice multiple security seals in there. So before law enforcement comes, if law enforcement is not coming, maybe for an hour, for a little while, you would use the healthcare practitioner seal. You would sign it, date it, it would seal by, and then you would seal the kit with that. So if someone knows it's not open, and then you would open it when that law enforcement officer comes back. And that's when you would go through that checklist of all the forensic evidence that you've collected, and you would sign it over to that individual. And then the last thing in the kit is a number of paper envelopes. And that's where you would put the clothing on. Again, you would use one of those blank labels to say, white underwear worn at time of assault or worn to hospital post assault. So there's some various different sizes that you can collect some of your clothing in as well. So that ends our discussion on using the Sexual Assault Forensic Evidence Kit. There's my contact information on the screen. If you have more questions, or you would like any contacts from the RCMP or RCMP lab, I'm happy to connect you with any individuals that I can. And I encourage everyone just to connect within their jurisdiction to who those multidisciplinary team members are and check on where your local reporting guidelines are, as well as some of the maybe different practices and where you can get a kit. Thank you, everyone. Thank you.

RCMP Sexual Assault Evidence Kit

holistic care

survivors of sexual violence

trauma-informed care

informed consent

healthcare providers

reporting sexual assault

safety planning

follow-up care

chain of custody

sexual assault examination

forensic evidence